title: Can ultrasound be used as the primary screening modality for the localization of parathyroid disease prior to surgery for primary hyperparathyroidism? A review of 440 cases.
abstract: OBJECTIVE
  Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism.
  
  
  METHODS
  A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings.
  
  
  RESULTS
  440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78-86) versus 72% (95% CI 67-76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients.
  
  
  CONCLUSIONS
  Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La., USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levy
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Lillian C
authors.initials: LC
authors.lastname: Yau
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Cuda
authors.forename: Sheila N
authors.initials: SN
authors.lastname: Sheth
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult